Efficacy on par, although procedural time shortest with phased RF ablation

Action Points

Phased duty-cycled radiofrequency ablation might have some edge over other commonly-used ablation technologies for atrial fibrillation based on shorter procedural times, although outcomes appear similar across the board.

Note that while cryoballoon ablation took the same amount of time as irrigated radiofrequency, phased radiofrequency ablation was performed faster.

Phased duty-cycled radiofrequency ablation might have some edge over other commonly-used ablation technologies for atrial fibrillation (afib) based on shorter procedural times, although outcomes appear similar across the board in randomized data, a meta-analysis found.

However, when Sy's group adjusted the analysis to include only randomized data, they found that phased RF was comparable at best to irrigated RF for freedom from afib at 9 months (P=0.35), although maintained its advantage in procedural time (mean difference 60.16 minutes, 95% CI 17.39-102.93).

"There was insufficient evidence to suggest that one ablation modality is more efficacious than another," the authors wrote. "However, there was a consistent reduction in procedural duration association with phased RF in all analyses."

John D. Hummel, MD, of the Ohio State University Medical Center in Columbus, told MedPage Today in an email that he agreed with the authors' conclusions that there is insufficient evidence to give one technique an edge in efficacy over another.

Yet given that procedural duration does appear shorter with phased RF, it may still be the "preferred approach" for patients in whom procedural time may be important, Hummel noted.

Indeed, "potential 'savings' in procedural time with 'one-shot' techniques may improve resource utilization provided procedural efficacy is comparable to that of irrigated RF," according to Sy's group.

The authors added that "it has been proposed that phased RF may be a superior ablation technology because of its ability to deliver both unipolar and bipolar RF energy which may create deeper, contiguous and more transmural lesions. Gaps in ablation lines may be expected to occur more frequently with the point-by-point irrigated RF when compared to 'single-shot' techniques such as phased RF and cryoballoon ablation."

They acknowledged that "improved outcomes with conventional RF have also been reported since the introduction of contact force technology and this was not consistently used in the component studies," however.

While cryoballoon ablation took the same amount of time as irrigated RF (P=0.10), phased RF was performed faster (P<0.0001).

Using only randomized data, irrigated RF beat cryoballoon ablation for freedom from afib at 1 year (OR 0.43, 95% CI 0.19-0.98), though procedural times were similar between both techniques (P=0.47).

But "it is noteworthy that all component trials used first-generation cryoballoon technology," the investigators wrote. "It remains to be seen whether the anticipated improvement in efficacy with the second-generation cryoballoon is realized in future clinical trials comparing cryoballoon ablation and irrigated RF."

"Likewise, improvements in phased RF technology such as optimization of phase and energy settings as well as the use of irrigation are expected in the future," they added.

Two limitations to the meta-analysis were the inconsistent reporting of outcomes -- especially safety outcomes -- and the inclusion of mixed populations with paroxysmal and persistent afib.

That may be why there is a "critical need" for more contemporary randomized studies comparing available ablation technologies, the authors emphasized, adding that they "eagarly await results from the FIRE AND ICE trial, a prospective, randomized, non-inferiority trial comparing cryoballoon ablation and irrigated RF, aiming to recruit 768 patients with paroxysmal afib."

Sy disclosed no relevant relationships with industry.

Hummel reported consulting for Medtronic.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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